New York hospitals are gearing up for a monthlong fight to stop Congress from reducing funding to facilities that treat a large percentage of Medicaid and uninsured patients on Oct. 1.

The oft-delayed cuts to the Disproportionate Share Hospital program would strip $700 million from New York hospitals in the next fiscal year and $1.3 billion the following year.

"Our top priority is to make sure these cuts don't go into effect," said Cristina Batt, vice president of federal relations for the Healthcare Association of New York State. "I think it's an understatement to say they would be devastating across the field."

The cuts are part of the Affordable Care Act and were designed to help fund the law. The assumption was that as more people became insured hospitals would have less uncompensated care.

But that relief did not materialize, Batt said.

A bill to eliminate the cuts for the next two years and cut them in half in the third year passed the House Energy and Commerce Committee in July. But the issue likely needs to be attached to a broader legislative package—one that will offset the money with savings—to pass the House. The Senate also would need to act before Oct. 1.

"DSH funding is essential to ensuring that financially struggling safety-net hospitals can continue to serve low-income individuals and vulnerable communities," a spokesman for the Greater New York Hospital Association said.

A frustrating wrinkle for hospitals is that one possible vehicle is federal legislation to prevent surprise medical bills. Hospitals are opposed to that bill because it uses benchmark pricing to resolve payment disputes with insurers.

"There are a lot of vehicles that legislation can take," Batt said. "The question is: What can get across the finish line by the end of the fiscal year?"

Rep. Eliot Engel has championed a delay to the cuts in the House, garnering support from more than 300 members on a letter supporting a delay. Rep. Chris Collins was the only member of the New York delegation who didn't sign on.

Sen. Charles Schumer this week expressed his support for a delay while outside Lewis County General Hospital in New York's North Country region. Gov. Andrew Cuomo issued a statement Thursday urging Congress to restore the money.

"I am calling on Congress to immediately rescind these impending cuts before they take effect on October 1st," he said in a statement. "If they don't, they will put critical health care services at risk for millions of New Yorkers."

A federal appeals court last month ruled that the federal government could consider how much hospitals receive from Medicare and private insurers in deciding their Medicaid DSH funding, reversing a lower court's decision. If that ruling stands, hospitals' awards could decrease.

It could be more than a year before the issue is settled. Hospitals might want to start reserving money in case they see a dip in funding, said Scott O'Connell, a partner at law firm Nixon Peabody in Boston.

"This is an issue that was resolved but is now uncertain," O'Connell said.

Congress has delayed cuts to Disproportionate Share Hospital funding four times since 2013. It most recently did so in February 2018 after failing to reach an agreement by an Oct. 1, 2017, deadline.

To get a bill passed, supporters of a delay will have to get Congress' attention while it's trying to fund the government for the next fiscal year. Hospitals might have to fight for a retroactive delay after Oct. 1.

"If this is not done at the end of the month, the fight doesn't stop there," Batt said. "It ends when we pass a fix and get these cuts delayed." —Jonathan LaMantia

NYU Langone plans $7M clinic for fast-growing bowel specialty

NYU Langone Health is seeking approval from the state for a $7 million extension clinic for its Inflammatory Bowel Disease Center.

Through the project, NYU Langone plans to provide a central locale for the fast-growing IBD program at 305 E. 33rd St. in a commercial condominium unit it owns. The program is not currently housed in one location.

The program's clinical team sees patients from the five boroughs, Long Island and the tristate area as well as out-of-state and international patients, according to a certificate-of-need filing for the clinic. And demand for services provided through the program is high, with the average appointment wait time climbing to more than five weeks at times.

"With nearly 12,000 visits projected for fiscal year 2019 across clinic appointments, infusions and other services, it is imperative that the program be relocated to a larger space to allow for the provision of high-quality, patient-centered care for an increased number of patients," NYU Langone said in the filing.

The program provides what it calls a patient-centered and multidisciplinary approach to treating IBD. That includes Crohn's disease and ulcerative colitis, which together affect 3 million people in the U.S., according to the American Gastroenterological Association. Services of the program range from medical and surgical to nutritional, psychosocial and ostomy care.

The new clinic also will provide space for research focused on developing new approaches to care with the goal of ultimately customizing treatment options based on biogenetics. —Jennifer Henderson

Veterans find work at Mount Sinai through nonprofit initiative

Mount Sinai Health System is one of several local health care employers working with the city nonprofit Workforce Opportunity Services, which trains and places U.S. military veterans.

Three veterans working with the nonprofit were placed within the health system's IT department in roles in data security, desktop support and client services.

Workforce Opportunity Services, founded in 2005, has worked with 65 corporations to find jobs for veterans. The nonprofit employs the workers, who work for organizations such as Mount Sinai as contractors, so it can provide additional support services. WOS can help employees with housing, transportation and other expenses, and it provides them with health benefits.

"Part of the program fee [for employers] covers those out-of-the-box expenses that these individuals might need over the course of their employment," a spokeswoman for the nonprofit said.

When the participants' 12-month placements end, Mount Sinai will have to decide whether to hire them.

Other local organizations that have worked with the nonprofit include Bristol-Myers Squibb, Horizon Blue Cross Blue Shield of New Jersey and Weill Cornell Medicine.

Roger Braman, senior director of information technology at Mount Sinai, has coordinated the program for the health system. Braman, a Navy veteran, said it can be a challenge for military personnel entering the civilian workforce to translate how their experience relates to corporate jobs.

Navy veteran Jonathan Duchnowski, for example, was a nuclear technician responsible for testing water quality and monitoring radiation in the service. While that role doesn't translate at Mount Sinai, Braman placed him in a project-management role.

"The training you get in the military is very good, but it's very specific to the branch you're in and role you have," Braman said. "A lot of employers don't understand how a certification in the military translates to jobs in the civilian world." —J.L.

Northwell operating profit climbs

Northwell Health reported an operating profit of $69.9 million for the first half of 2019, compared with $52.9 million for the same period last year. The operating margin also ticked up, to 1.2% from 0.9%.

Net patient service revenue clocked in at $4.6 billion for the first six months of the year, representing an increase of 8.3% compared with the first half of 2018. And total operating revenue was $6.1 billion, up 8.8%.

Total operating expenses approached $6 billion for the first half of the year, up 8.6% compared with the same period last year.

The increase in operating expenses was partially attributable to continued investments in areas such as facilities and programs to expand capacity and rebuild existing infrastructure as well as population health management for the transition to value-based payment models.

Northwell said its management continues to focus on patient experience, market-share growth and diversification of revenue streams.

"Maintaining the balance sheet and improving operating results also remain top management priorities so that Northwell can continue to invest in people, programs and facilities," Northwell stated, "to successfully adapt and respond to changes in the health care industry while continuing to meet the needs of patients and families in all the communities it serves." —J.H.

AT A GLANCE

VAPING ILLNESSES: The state Department of Health on Thursday announced new findings of its ongoing investigation into vaping-associated pulmonary illnesses, which have been reported across the state. To date, the department said, it has received 34 reports from New York physicians of severe pulmonary illness among patients ranging from 15 to 46 years old who were using at least one cannabis-containing vape product before becoming ill. Laboratory tests showed "very high levels of vitamin E acetate" in nearly all cannabis-containing samples analyzed by the Wadsworth Center. "In general, vaping of unknown substances is dangerous, and we continue to explore all options to combat this public health issue," Health Commissioner Dr. Howard Zucker said in a statement.

WHO'S NEWS: Dr. Laura Alonso has been named chief of the Division of Endocrinology, Diabetes and Metabolism at Weill Cornell Medicine and New York-Presbyterian/Weill Cornell Medical Center. Alonso also will lead the Joan and Sanford I. Weill Center for Metabolic Health at Weill Cornell Medicine. She joins from the University of Massachusetts Medical School in Worcester, where she served as director of beta cell biological studies in the Diabetes Center of Excellence, among other positions.

Khurrum Malik has joined Blink Health, which offers discounts on prescription drugs, as head of growth marketing. He most recently was chief marketing officer at real estate brokerage Compass and has held marketing roles at Spotify, Facebook and Microsoft.

GENE THERAPIES: Cigna and CVS Health plan to introduce insurance products to help employers pay for expensive gene therapies, such as Novartis' Zolgensma to treat spinal muscular atrophy. Zolgensma costs $2.1 million for a one-time dose, The Wall Street Journal reported. Spinal muscular atrophy, an inherited muscle-wasting disease, can kill children before their second birthday without treatment.

CLARIFICATION: Correctional Health Services previously offered discharge planning to inmates with mental health conditions, HIV and other complex health conditions when the services were administered by the city Department of Health and Mental Hygiene. The description of the history of discharge planning at city jails was incomplete in the At a Glance section of the Sept. 4 edition of Health Pulse.

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